National Strategic Plan for Reproductive Health Commodity Security

Publication date: 2003

[image: image1.emf] Foreword Reproductive Health Commodity Security (RHCS) was recognized as an issue when leaders in reproductive health realized that the demand for RH commodities was increasing around the world as resources available for providing them (RH commodities) declined. In the case of contraceptives, the worldwide gap between needed supplies and the funds available for procuring supplies is projected to reach $4.21 billion by 2015. In 2001 an international conference titled, ‘Meeting the Reproductive Health Challenge: Securing Contraceptives and Condoms for HIV/AIDS Prevention,” was held in Istanbul, Turkey. At this conference, the need to develop a secure supply of RH commodities was first recognized. In response, participants called for the development of a common approach to RHCS. An international workshop was held in 2001 in Washington DC to discuss the concept of a Common Assessment Framework (CAF), after which a committee was formed to develop the CAF. The Committee eventually decided to broaden the scope to include all RH commodities and the CAF became the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS - pronounced “sparks”). SPARHCS is a comprehensive, long-term, holistic approach, which seeks to help countries develop a strategy to ensure that sufficient RH commodities and supplies will be available in the future. The SPARHCS framework is designed to be adapted to the needs and conditions of individual countries. This initiative was supported by more than 40 international organizations including USAID, UNFPA, WHO, World Bank, DFID, Packard Foundation, multiple implementing agencies and international stakeholders. The development of this RHCS Strategic Plan coincided with several important reforms initiated by the Federal Government of Nigeria. These included revitalization of the National Contraceptives Logistics Management System, approval and launch of the National Reproductive Health Policy, the National Reproductive Health Strategic Framework and Plan: 2002-2006, and the ongoing review of the National Population Policy. The RHCS Strategic Plan is designed to operationalize the FP, HIV/AIDS and STI components of the above documents. To define the family planning situation and condom requirements for prevention of STI/HIV/AIDS in Nigeria, the SPARHCS Framework was used to conduct a basic diagnosis of the existing CLMS and related systems. The outcome of this diagnosis formed the basis of the RHCS Strategic Plan. It is my belief that implementation of this multi-partner strategy will assist Nigeria to progress toward the time when commodities and supplies are readily available at all levels so that men, women and youth can choose, obtain and use quality contraceptives and condoms for HIV/AIDS whenever they need them. [image: image2.png] Prof. Eyitayo Lambo The Honourable Minister of Health October 2003 Acknowledgement The Department of Community Development and Population Activities of the Federal Ministry of Health is sincerely grateful to the various individuals and Development Partners who worked with us in ensuring the reality of this document. In particular, our appreciation goes to the USAID Washington, USAID Nigeria, and UNFPA that funded the development of the National Population Policy, National Reproductive Health Policy and the Reproductive Health Commodity Security Strategic Plan. Our thanks also go to the POLICY Project/Nigeria, POLICY Project/Washington and DELIVER/Washington for providing the technical assistance for the development of this document. Worthy of mention is the expanded SPARHCS technical Core Group which tirelessly worked on the draft RHCS Strategic Plan. Finally, my appreciation goes to the dynamic Reproductive Health and Population Activities Divisions of the Department of Community Development and Population Activities, headed by Dr. Adenike Adeyemi and Dr. Akinremi Dada, ably assisted by Dr. M.A. Odeku, Dr. Bose Adeniran, Mrs. Pauline Aribisala and Mr. Lawrence Anyanwu amongst others. I acknowledge the contributions of the above individuals and teams towards the ongoing efforts at putting in place the RHCS Strategic Plan for Nigeria. I do sincerely look forward to everyone’s continuing participation in the course of implementation of this plan. [image: image3.png] Dr. M. S. Amaeshi Director, Community Development and Population Activities List of Abbreviations BCC - Behavioural Change Communication CLMS - Contraceptives Logistics Management System CPR - Contraceptive Prevalence Rate CS - Contraceptive Security CSOs - Civil Society Organisations CSP - Clinical Service Provider DCDPA - Department of Community Development and Population Activities Dev. Partners - Development Partners FGON - Federal Government of Nigeria FIS - Financial Information System FMOE - Federal Ministry of Education FMOH - Federal Ministry of Health FMOF - Federal Ministry of Finance FMOI&NO - Federal Ministry of Information and National Orientation FMOJ - Federal Ministry of Justice FMWA&YD - Federal Ministry of Women Affairs and Youth Development FMIS - Financial Management Information System FP - Family Planning GE - Guild of Editors HIV/AIDS - Human-Immuno Virus / Acquired Immune Deficiency Syndrome HPR - Health Planning and Research IEC - Information, Education, and Communication IMR - Infant Mortality Rate IPC - Interpersonal Communication IT - Information Technology IUD - Intra-uterine Device JHU/CCP - John Hopkins University/Centre for Communication Programs KAP - Knowledge, Attitudes, and Practice LGAs - Local Government Areas LGA PHC - Local Government Area Primary Health Centre LMIS - Logistics Management Information System MCH - Maternal Child Health M&E - Monitoring and Evaluation MIS - Management Information System MIS Division - Management Information System Division MMR - Maternal Mortality Rate NERDC - Nigeria Educational Research Development Council NHRC - National Human Rights Commission NDHS - National Demographic and Health Survey NGOs - Non-Governmental Organisations NPC(I) - National Population Commission NPC(11) - National Planning Commission NPHCDA - National Primary Health Care Development Agency NUJ - Nigerian Union of Journalists OD - Operational Development PA Division - Population Activities Division PHC - Primary Health Care PICB - Population Information Communication Bureau RH - Reproductive Health RHCS - Reproductive Health Commodity Security SDP - Service Delivery Point SMOH - State Ministry of Health SMOJ - State Ministry of Justice SMOWA - State Ministry of Women Affairs SOP - Standards of Practice SPARHCS - Strategic Pathway for Reproductive Health Commodity Security STIs - Sexually Transmitted Infections TOTs - Training of Trainers UNFPA - United Nations Populations fund USAID - United States Agency for International Development WDC - Women’s Development Centre Table of Contents Foreword ------------------------------------------------------------------------------ i Acknowledgement --------------------------------------------------------------------- ii Acronyms ------------------------------------------------------------------------------- iii Table of Contents ------------------------------------------------------------------------- vi Executive Summary --------------------------------------------------------------------- 1 Guide to Terminology used in the Strategic Plan ------------------------------------ 3 Overview of Components ------------------------------------------------------------- 4 Component Summary – Finance -------------------------------- 6 Detailed Plan --------------------------------- 7 - 12 Policy Component - Summary ------------------------------------- 13 Detailed Plan -------------------------------- 14 - 19 Logistics Component - Summary ------------------------------------- 20 - Detailed Plan -------------------------------- 21 - 27 Service Delivery Component - Summary ------------------------------------- 28 - Detailed Plan -------------------------------- 29 - 33 Demand Component - Summary ------------------------------------- 34 Detailed Plan -------------------------------- 35 - 38 Coordination Component - Summary ------------------------------------ 39 - Detailed Plan ------------------------------- 40 - 45 References ---------------------------------------------------------------------------- 46 Executive Summary The purpose of this Strategic Plan is to define the steps required to achieve Reproductive Health Commodity Security (RHCS) in Nigeria. The goal of Reproductive Health Commodity Security is to improve the quality of life of Nigerians by ensuring that all men, women and youth can choose, obtain and use contraceptives, including condoms for the prevention of STIs and HIV/AIDS. The National Strategic Plan for Reproductive Health Commodity Security was developed using the SPARHCS process as described in the Foreword of this document. During the development of the Strategic Plan, a basic diagnosis of problems impacting on RHCS was conducted, which identified the following issues: Inadequately functioning logistics system, with deficiencies in availability of RH services and commodities; Inadequate political commitment and financial support for RHCS at the Federal, State and Local Government levels; Lack of management coordination among stakeholders working in the field of RHCS; Inadequate standards of practice for RHCS; and Low level of male involvement in RHCS. Short- and long-term tasks were developed to address the above issues, and were subsequently transformed into this RHCS Strategic Plan. The Strategic Plan covers RHCS for contraceptives and condoms for STI and HIV/AIDS prevention, collectively referred to as “RH Commodities.” The package of RH commodities in this Plan includes supplies for all modern methods of contraception, including condoms which are used in the prevention of HIV/AIDS and other sexually transmitted infections (STIs). The “dual role” of condoms in the provision of contraception is also recognized. The development of this comprehensive Strategic Plan required the participation a number of stakeholders. These stakeholders, plus others yet to become involved, will also partake in the funding and implementation of the plan. Stakeholders are drawn from a number of different concerned groups and organizations: Government; Donors and Partners; NGOs/Civil Society; Private Sector Organisations; Individuals. The Strategic Plan contains six Components, each of which addresses a specific Strategic Objective: Component Strategic Objective Finance To promote the provision of secure and permanent financial support for contraceptives among governmental, non-governmental and private organizations and individuals. Policy To reduce legal, human resource, financial, cultural, informational and operational barriers in order to mitigate their impact on the provision and use of quality contraceptives and related services. Logistics To ensure that contraceptives and condoms are supplied in the right quantities in a timely and efficient manner at all levels. Service Delivery To increase and secure permanent access to and use of safe, comprehensive, reliable and high quality contraceptives and related services. Demand To create processes and mechanisms that promote a balance between the demand for and the supply of quality contraceptives and to promote demand in order to increase low-levels of contraceptive prevalence. Coordination To develop and promote political, governmental, organizational, public/private and socio-cultural coordination focused on ensuring continued planning, management and provision of contraceptives and related services. Estimated Budget: The amounts listed below are the totals taken from the estimated costs of implementing the activities and sub-activities proposed in the RHCS Strategic Plan. At the time of the drafting of the Plan, only partial commitments of these funds had been secured. A determined effort will be undertaken on the part of the FMOH and its partners to secure from stakeholders the remaining financial and other commitments required to fully support the Plan. Estimated Budget Component (millions of Naira) (millions of US dollars) Finance 257.3 1.979 Policy 175.0 1.346 Logistics 2,941.5 22.627 Service Delivery 1,063.4 8.180 Demand 300.5 2.312 Coordination 156.7 1.205 Total 4894.4 37.649 (Conversion rate at N130.00 = US $1) The FMOH, as the coordination agency responsible for the implementation of the Strategic Plan, expects that all commitments secured from all stakeholders in the process of endorsing and adopting the RHCS Plan for 2003-2007 will be sustained throughout the time of reference. The continued commitment to partnership and funding of this Plan in totality will ensure RHCS in Nigeria. Guide to Terminology Used in the Strategic Plan Each of the six Components of the Strategic Plan is described in detail in this document. Every Component contains an overall Strategic Objective that describes the broad level of accomplishment expected within the component. Strategic Objectives are further broken down into a number of Objectives that give details of the expected accomplishments for each component. Objectives are in turn described in terms of the following: Issues Addressed: The specific problems or opportunities on which the objective focuses. Activities and Subactivities: A listing of the actions necessary to achieve the objectives. Coordinating Agency: For each component, the Federal Ministry of Health is the agency which coordinates the activities and sub-activities which will be undertaken. Coordination implies the harmonization, management, synchronization and direction of the activities undertaken by implementing agencies. The FMOH assumes overall responsibility for ensuring the accomplishment of all activities in the Strategic Plan. The specific office in the FMOH to assume this role is the Department of Community Development and Population Activities. Implementing Agencies: Each activity and sub-activity requires at least one organization to take responsibility for the accomplishment of the required actions. These implementing agencies will work under the coordination and direction of the FMOH/DCDPA. Estimated Budget (Naira): The estimated cost of implementing every activity and sub-activity. These figures should be considered as broad approximations until more detailed budgets are developed. Timing: The approximate time during which the activities and sub-activities are planned to be accomplished. Activities are marked as “done” where they have already been accomplished. Some activities are listed as “ongoing” which indicates that implementation has begun, but is not yet complete. Output Indicators: Statements which describe the quantifiable products of the activities once implementation is complete. Outcome Indicators: A description of the measurable results which will be obtained once the outputs of the activities have been realized. Assumptions: A listing of the preconditions, requirements and circumstances that must exist before and during the successful implementation of activities in the plan. OVERVIEW OF COMPONENTS Component Strategic Objective Major Issues Addressed Estimated Budget (Naira) Indicators Principal Assumptions Finance To promote the provision of secure and permanent financial support for contraceptives among governmental, non-governmental and private organizations and individuals. * Access to financial data; * Market Segmentation; * Resource mobilization; * Management capacity; * User fees/cost-recovery * Government support; * Public support * Donor support * Advocacy 99.3m * Financial data used to secure funding from government and donors * CS program of activities receives sustained annual budgetary support. * % of Health facilities implementing the cost recovery system effectively * % of states and LGAs which have a functioning effective FMIS * % of clients willing and able to pay for services * Donor funding for contraceptives increases * Favorable political environment * Continued donor support * Positive response from the key policy makers Financial mismanagement * Collaboration between various levels of government, NGOs/Private Sector FMIS * FMIS and LMIS fully functional Policy To reduce legal, human resource, financial, cultural, informational and operational barriers in order to mitigate their impact on the provision and use of quality contraceptives and related services. * Social and cultural barriers; * Regulatory barriers; * Gender equity; * Government commitment * Legal reform * Policy/data analysis * Advocacy 1.701b * % Reduction IMR, MMR, Pop growth rate, * % Increase in life expectancy, in school enrolment rate especially for girls, * % Decrease in STI/HIV/AIDS prevalence; * existence of gender supportive policies and programmes, * % Increase in No. of youth friendly centres * Continued political stability; * Availability of funds; * Policy makers and opinion leaders are willing to support RHCS issues * Increased Political commitment and support Logistics To ensure that contraceptives and condoms are supplied in the right quantities in a timely and efficient manner at all levels. * Forecasting; * Procurement; * Distribution; * Logistics management capacity; * Logistics Management Information System 1.2165b * Sufficient commodities procured to meet public sector needs * Adequate mix of contraceptive commodities available in SDP and stores * Increased logistic data available for mgt. decision making * % decrease in stock out rate of contraceptives in SDPs and stores * Availability of adequate/appropriate mechanisms * Donors & Govt. ready to provide funds to support the process Service Delivery To increase secure and permanent access to and use of safe, comprehensive, reliable and high quality contraceptives and related services. * Training * Infrastructure support * Data collection and analysis * Supervision * Provider skills * Method mix * Service quality * Client satisfaction * Counseling 305.7m * % SDP with trained CSPs * % of SDP with basic minimum package for RHCS * No of ME reports * Reports of performance monitoring evaluation * % of SDPs offering FP Services * % of client expressing client satisfaction Assumptions: * Availability of funds, * Political stability, * Timely release of funds, * Budgetary release of funds Risks: * Male opposition to women participation * Absence of communal strife * Donor fatigue * Continued acceptance of the programme Demand To create processes and mechanisms that promote a balance between the demand for and the supply of quality contraceptives and to promote demand in order to increase low-levels of contraceptive prevalence. * Market segmentation * Unmet demand * CPR * Public awareness & sensitization 268m * % increase in Contraceptive Prevalence Rate Coordination To develop and promote political, governmental, organizational, public/private and socio-cultural coordination focused on ensuring continued planning, management and provision of contraceptives and related services. * Donor participation * Private sector participation * Information dissemination * Regulatory barriers * Infrastructure development * Data collection and analysis * CS planning and monitoring 96.7m * Increased donor participation; * Improved management and information dissemination; * Regulatory barriers and tariffs removed; Assumptions: * That funds will be available; * Staff of coordination base will be committed to support RHCS; * Increased donor funding. Risks: * Donor fatigue * Political Instability Component Summary Component No. 1: Finance Strategic Objective: To promote the provision of secure and permanent financial support for contraceptives among governmental, non-governmental and private organizations and individuals. Major Issues Addressed: Access to financial data; Market Segmentation; Resource mobilisation; Management capacity; User fees/cost-recovery Government support; Public support; Donor support; Advocacy. Estimated Budget (Naira): 257.3m Indicators: Financial data used to secure funding from government and donors CS program of activities receives sustained annual budgetary support. Percent of Health facilities implementing the cost recovery system effectively. Percent of states and LGAs which have a functioning effective FMIS. Percent of client willing and able to pay for services. Donor funding for contraceptives increases. Assumptions: Favorable political environment Continued donor support Positive response from the key policy makers Financial mismanagement Collaboration between various levels of government, NGOs/Private Sector FMIS FMIS and LMIS fully functional Component: Finance Objective: 1.1 To ensure that key decision makers and financial managers at national, state, and local levels are provided with current and reliable data related to contraceptive security financial requirements. Issues Addressed: Validity, reliability and comprehensiveness of financial data; To ensure that key policy/decision makers make use of the financial data in planning; Evidence based planning and decision making. Coordinating Agency: FMOH/DCDPA Assumptions: Favourable political environment Continued donor support Positive response from the key policy makers Collaboration between various levels of government and NGOs/private sector Financial management Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 1.1.1 Develop financial management information system (FMIS) for effective planning, monitoring and evaluation of CS FMOH, DCDPA, HPR Total: 28.3m % of states and LGAS effectively using FMIS Structures developed and maintained at State and National levels Financial data used to secure funding from government and donors Subactivities 1.1.1.1 Set up a committee to determine needs of CS financial information system. " 1.2m 4th quarter 2004 Needs for FMIS identified 1.1.1.2 a) Develop RHCS financial information system in response to identified needs. " 12m 4th quarter 2004 FMIS developed 1.1.1.2 b) Provision of forms and stationery for FMIS 2.0m Forms and stationery supplied % of States and LGAs with adequate forms and stationery 1.1.1.3 Develop FMIS training curriculum DCDPA, HPR, LGAs, SMOH, 0.5m 1st quarter 2005 FMIS training curriculum developed 1.1.1.4 Train Financial Managers on FMIS DCDPA, HPR, LGAs, SMOH, 9.6m 1st quarter 2005 No. of financial managers trained in the use of FMIS % of States and LGAs with manager trained in FMIS 1.1.1.5 Generate quarterly and annual reports on the financial status of commodities DCDPA, HPR, SMOH, LGAs, NGOs 1.0m 2005 quarterly No. of financial managers who make quarterly reports using the FMIS % of states and LGAs which have a functioning effective FMIS 1.1.1.6 Review the FMIS periodically DCDPA, HPR, SMOH, LGAs, NGOs 2.0m 2006 yearly Component: 1.0 Finance Objectives: To increase and diversify the amount of resources available for contraceptives, HIV/AIDS condoms and related services. 1.2a To improve government support and funding for contraceptives and related services Issues Addressed: RHCS program sustainability; Appropriate government budgetary allocation and prompt release of funds for RHCS; RHCS program sustainability. Coordinating Agency: FMOH/DCDPA Assumptions: Positive response from government Political stability Prompt budget release Availability of funds Zero budget allocation Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 1.2.1 Development of advocacy program for government support and funding for contraceptives and related services FMOH, DCDPA Total: 128.5m Oct-Dec 2003 No. of states in which advocacy program is implemented. CS program of activities receives sustained annual budgetary support. No. of states providing annual budgetary support Quantity of commodities purchased and distributed Subactivities 1.2.1.1 Determine amount spent at the LGA, state and federal government levels for FP commodities and services. 0.9m Report of study 1.2.1.2 Conduct cost studies FMOH and dev. partners see 1.2.1.1 3rd quarter 2004 Report of study 1.2.1.2a Use forecast data to estimate FP funding requirements 0.6m Done Report of study 1.2.1.3 Organize and facilitate advocacy program focused on an annual effort to raise funds to support continued delivery of quality RH services. (18m/yr) 90m Development of Tools for advocacy No. of states in which advocacy campaigns are undertaken No. of states showing efforts at funding RHCS 1.2.1.4 Design and implement a contraceptive cost recovery system. FMOH/ DCDPA, states, LGAs, NGOs 37m (minus 25m for the UNFPA assisted states) Cost recovery system implemented % of SDPs implementing cost recovery system effectively Increased income from cost recovery % of SDPs with appropriate method mix available on supervisory visits % of clients willing and able to pay for services Component: 1.0 Finance Objectives: 1.2 To increase and diversify the amount of resources available for contraceptives, HIV/AIDS condoms and related services. Issues Addressed: Resource mobilization: clients RHCS sustainability Coordinating Agency: FMOH/DCDPA Assumptions: System in place to ensure that the poor and adolescents have access to contraceptives Minimal bureaucratic bottlenecks in processing duty exemptions. Avoid Provider Bias Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activities 1.2.2 Design and implement a contraceptive cost recovery system. FMOH/DCDPA, States, LGAs, NGOs Total: 82m Done Cost recovery system implemented % of Health facilities implementing the cost recovery system effectively Increased income from cost recovery % of health facilities with appropriate method mix available on supervisory visits % of clients willing and able to pay for services Subactivities 1.2.2.1 Conduct willingness to pay study for public sector contraceptives to re-evaluate prices FMOH.DCDPA, States, LGAs, NGOs, Dev. Partners 20m 2006 Report of study 1.2.2.2. Set prices for public sector contraceptives Ditto Done Prices for public sector commodities set 1.2.2.3 Design cost recovery system including exemption policy and use of funds earned at each level of the system Ditto Done Cost recovery system designed 1.2.2.4 train relevant program staff on cost recovery Ditto (see Logistics component) Ongoing no. of relevant personnel trained in cost recovery % of states with trained personnel in cost recovery 1.2.2.5 Implement the cost recovery system FMOH, States, LGAs, NGOs,Unifor-med services Ongoing implementation of the cost recovery system commenced % of states implementing the cost recovery system 1.2.2.6 Monitoring and Evaluate the cost recovery system regularly 12m (4 years) 2004 (yearly) yearly evaluation report of the cost recovery system Results of evaluation used to improve cost recovery system Component: 1.0 Finance Objectives: 1.2 To increase and diversify the amount of resources available for contraceptives, HIV/AIDS condoms and related services. 1.2b To mobilize donor support for contraceptives and related services Issues Addressed: Resource mobilization: donors Coordinating Agency: FMOH/DCDPA Assumptions: Political Stability; FMIS and LMIS fully functional Sustained donor support (avoid Donor fatigue) Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 1.2.3 Develop advocacy package for donors and private sector FMOH/ DCDPA, states, LGAs, NGOs Total: 2.5m Advocacy package disseminated Donor commitment to fund commodities secured. Donor funding for contraceptives increases Amount actually spent on commodities Subactivities 1.2.3.1 Drawing from FIS and logistics data, prepare regular reports on CS status (stock status and financial expenditures/commitments) Ditto 0.5m annually Report written 1.2.3.2 Demonstrate government commitment through funding. Ditto annually Report written 1.2.3.4 Demonstrate through LMIS and service data that donated commodities are reaching intended clients Ditto 1.0m annually Report written 1.2.3.5 Follow-up on donor commitments to ensure products/funds are provided in timely manner Ditto 1.0m ongoing Component: 1.0 Finance Objectives: To ensure that key decision and policy makers, financial managers and opinion leaders at national, state and local government levels have access to current and reliable data related to policies and budgets in support of RH commodity security requirements. Issues Addressed: RHCS data for decision makers Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Political stability Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 1.3.1 Design and implement an information program focused on information needs of principal stakeholders at each level of Nigeria's administrative structure DCDPA Dev. Partners, State, LGAs Total: 10m Multi-level RHCS information system for stakeholders implemented Annual RHCS budget support needs reflected as annual GON budget line item Subactivities 1.3.1.1Conduct a rapid assessment of information needs of decision makers DCDPA Dev. Partners, States, LGAs 5m Feb-04 Information needs of policy makers identified Expressed commitment on RHCS by policy makers 1.3.1.2Develop and implement plan to respond to identified information needs DCDPA Dev. Partners, States, LGAs 2m Apr-04 Advocacy plan of action in place 1.3.1.3Facilitate annual RHCS information seminar DCDPA Dev. Partners, States, LGAs 3m Oct 2003 & Annually No. of participants attending annually Component: 1.0 Finance Objectives: 1.3 To ensure that key decision and policy makers, financial managers and opinion leaders at national, state and local government levels have access to current and reliable data related to policies and budgets in support of RH commodity security requirements Issues Addressed: Effective use of data by policy makers Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Assumption: Policy makers will respond positively to the information provided Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 1.3.2 Improve policy makers access to RHCS data Total: 6m Periodic presentation of RHCS data to key policy makers Annual parliament policy and budgetary support for RHCS priorities Subactivities 1.3.2.1 Restructure format of data presentation for policy makers DCDPA Dev. Partners, States, NGOs 5m Mar-04 No. of advocacy tools developed 1.3.2.2 Facilitate periodic task force development of responses/options for consideration by policy makers DCDPA Dev. Partners, States, NGOs 3m May-04 Annual meeting of task force Annual RHCS budget support needs reflected as annual FGN budget line item Component Summary Component No. 1: Policy Strategic Objective: To reduce legal, human resource, financial, cultural, informational and operational barriers in order to mitigate their impact on the provision and use of quality contraceptives and related services. Major Issues Addressed: Social and cultural barriers; Regulatory barriers; Gender equity; Government commitment Legal reform Policy/data analysis Advocacy Estimated Budget (Naira): 175 million Indicators: Existence of improved policy environment on legal, human, financial, cultural and operational issues on RHCS. Increase in life expectancy. In school enrolment rate especially for girls. % decrease in STI/HIV/AIDS prevalence. Existence of gender supportive policies and programmes % increase in No. of youth friendly centres Assumptions and Risks: Continued political stability; Availability of funds; Policy makers and opinion leaders are willing to support RHCS issues; Increased Political commitment and support Component: Policy Objective: 2.1 To reduce socio-cultural barriers to commodity security Issues Addressed: Social and cultural barriers to RHCS access and use of contraceptives and condoms for the prevention of HIV/AIDS Coordinating Agency: FMOH Assumptions: Political stability and support for FP/RH issues at all levels. Budgetary allocations & timely release of funds Availability of funds & other resources Donor support is sustained Activities and Sub-activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 2.1 Develop and implement programs to reduce identified social and cultural barriers to reproductive health commodity security. DCDPA/FMOH, Dev. Partners, NGOs, CSOs, SMOH, LGA & Uniformed Agencies Total: 64m Social and cultural barriers to RHCS identified and eliminated Sub-activities 2.1.1. Facilitate workshop to reach consensus on identification of social and cultural barriers especially on women. DCDPA/FMOH, SMOH, Dev. Partners, NGOs, CSOs, NPHCDA, other stakeholders 14m Oct-Dec 2003 Socio-cultural barrier reduction program implemented 6 zonal & 1 national consensus workshops conducted. Advocacy meetings Local level awareness programmes conducted. National KAP indicates positive KAP at all levels toward reproductive health issues. Increases in the % of women, men & young persons who have access to and use contraceptives 2.1.2 Design and implement sector-wide program to remove barriers(Advocacy/IEC/BCC) " 50m 2004 - 2005 & on-going 1 national workshop designed and conducted. IEC/BCC materials developed & disseminated No. of IEC materials produced and disseminated. Component: 2.0 Policy Objectives: 2.1 To strengthen the existing multisectoral and multidisciplinary institutional & legal framework for RH Commodity Security Issues Addressed: Legal and institutional barriers to RH Commodity Security. Coordinating Agency: FMOH Assumptions and Risks: Political stability and support to CS issues Activities and Sub-activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 2.2.1 Develop and implement program to reduce institutional and legal barriers to reproductive health commodity security DCDPA/FMOH, FMWAYD, WDC, FMOJ, SMOH, SMOJ, SMOWA, LGAs, NGOs & Uniformed Agencies NHRC, Parliamentary groups. Total: 27.5m    Institutional and legal barriers to RHCS identified and eliminated 2.2.1 Sub-activities       2.2.1.1 Facilitate technical roundtable to identify institutional and legal barriers. Ditto 5m Jan.4 Legal barrier reduction program implemented Baseline information on institutional & legal barriers produced & documented Institutional and National KAP Survey indicates positive KAP at all institutional and legal levels toward reproductive health commodity security issues. 2.2.1.2 Design and implement program to remove institutional and legal barriers to RHCS. Ditto 8m Feb-Mar 2004 and ongoing Program design W/shop implemented Increased No. of positive Legal Institutional framework established & operational 2.2.1.3 Facilitate FGN launch of RHCS Strategic Plan. Ditto 3m Dec-03 RHCS Strategic Plan launched RHCS operational at all levels 2.2.1.4 Disseminate RHCS Strategic Plan document Ditto 1.5m Dec 2003 & on-going 5000 copies of RHCS document produced and disseminated RHCS available and in use at all levels 2.2.1.5 Facilitate FGN annual review of RHCS Programme. Ditto 10m Oct 04 & Annually Annual review meetings held Performance report on RHCS programme shared. Component: 2.0 Policy Objectives: 2.3 To promote national recognition and support for gender issues and reproductive rights Issues Addressed: Government and public support for policies related to gender equity and reproductive rights. Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Political stability & support to RHCS issues Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 2.3.1 Develop and implement programmes to support positive response to gender issues and reproductive rights. DCDPA/FMOH, FMWAYD, WDC, FMOJ, SMOH, SMOJ, SMOWA, CSOs, NGOs, NPC Parliamentary groups, Dev. Partners Total: 16m Gender bias reduced and reproductive rights improved Sub-activities 2.3.1.1 Conduct analysis of policies & legislation related to gender and reproductive rights. DCDPA/FMOH, FMWAYD, WDC, FMOJ, SMOH, SMOJ, SMOWA, CSOs, NGOs, Parliamentary groups, Dev. Partners 3m Feb 04 Analysis of policies & legislation related to gender & RH conducted Baseline data on gender & reproductive rights produced National KAP indicates positive KAP related to gender and reproductive rights issues Equality of women & men who have access to & use FP services as at when needed 2.3.1.2 Define and implement strategies to respond to findings associated with gender and reproductive rights policies & legislation. DCDPA/FMOH, FMWAYD, WDC, FMOJ, SMOH, SMOJ, SMOWA, CSOs, NGOs, Parliamentary groups, Dev. Partners 3m May 04 Supportive legislation and policies on gender and reproductive right enacted and operational Gender and reproductive rights support programs implemented. Equal opportunities and reproductive right for both men and women Women, men and young people are able to choose and use and RH and STI/HIV/AIDS services 2.3.1.3 Design and implement advocacy & BCC/ IEC programs to promote gender equity. 10m Aug 04 Advocacy, IEC/BCC programs to promote gender equity designed & implemented Increased support for gender related issues and reproductive rights. Component: Policy Objectives: To increase the level of awareness on contraceptive security issues among key stakeholders and decision makers at all levels Issues Addressed: Support for RHCS among health service managers and health providers & teachers in the public and private sectors. Coordinating Agency: FMOH Assumptions and Risks: Favourable Political environment Availability of funds Low attrition of sensitised workers Activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 2.4.1 Increase level of awareness of health providers & teachers on RHCS issues DCDPA/FMOH, FMOE, NERDC, SMOH Total:  26.5m   Health providers and teachers promote RG services 2.4.1 Sub-activities       2.4.1.1 Facilitate technical roundtable to identify critical health provider barriers to support for RHCS initiative. Ditto 5m Sept.04 Provider awareness program developed Critical RH provider barrier identified & documented conducted Provider KAP study indicates widespread commitment to RHCS program. Improved RH service provision by providers /health managers 2.4.1.2 Develop and support RHCS advocacy and barrier reduction program in collaboration with media and other opinion leaders. DCDPA/FMOH, FMOI, FMOE Dev. Partners, SMOH, National Orientation Agency, FMOE/NERDC, NUJ, NGOs, SMOH 10m Oct. 04 Advocacy program for media & opinion leaders Media and opinion leaders support RHCS 2.4.1.3 Sensitization of teachers at all levels on RHCS DCDPA/FMOH, FMOE NERDC SMOH 5m Sept. 04 Sensitization w/shop for teachers conducted Teachers teach RHCS issues in schools 2.4.1.4: Develop and disseminate RH fact sheets for teachers at all levels Ditto 1.5m Apr-04 RHCS Fact sheet produced & disseminated RHCS Fact Sheet in use to support RHCS 2.4.1.5 Increase media and other opinion leaders’ awareness and support for RHCS. DCDPA/FMOH, FMOI & No NUJ, GE, NGOs, CSOs, Dev Partners, SMOH   5m   Oct 04 Awareness raising workshop conducted for the media and opinion leaders Increased media support to RHCS Component: Policy Objectives: To increase level of awareness on contraceptive security issues among strategically-targeted stakeholders and decision makers (continued). Issues Media and opinion leaders’ support for RHCS Coordinating Agency: FMOH Assumptions and Risks: That work with opinion leaders will include representatives of civil societies, including religious organizations Activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 2.5 Develop and implement awareness raising and support programmes by the media and opinion leaders for RHCS DCDPA, FMOI&NO, SMOH, NUJ,GE, NGOs, LGAs Total: 26m Media & Opinion leader awareness program developed General public KAP study indicates widespread understanding and support of RHCS program. 2.5 Sub-activities 2.5.1 Facilitate informational roundtable to educate media and other opinion leaders to the importance of RHCS. Ditto 3m Sept. 2004 No. of roundtables held for the media and opinion leaders on RHCS issues The media group and opinion leaders better informed on RHCS issues 2.5.2 Develop and support RHCS advocacy programs for the media and other opinion leaders: Media kits & training of media personnel Ditto 8m Nov-04 Advocacy programme developed and implemented for the media personnel Media kits produced and in use Media programs/news items support RHCS 2.5.3 Facilitate annual roundtable updates on RHCS for media and other opinion leaders. Ditto 15m Oct. 04 and annually Annual round table meetings held No. of targeted community programmes conducted by the media (print/electronic) Enhanced community participation and access to RHCS services Component: 2.0 Policy Objectives: To ensure that key decision and policy makers, financial managers and opinion leaders at national, state and local government levels have access to current and reliable data related to policies and budgets in support of RH commodity security requirements Issues RHCS data for decision makers Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Multi-level RHCS information system for stakeholders implemented Activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 2.6.1 Design and implement an information program focused on information needs of principal stakeholders at each level of Nigeria’s administrative structure DCDPA, NPC, NGOs, Dev Partners, SMOH, LGAs Total: 10m Multi-level RHCS information system for stakeholders implemented Annual RHCS budget support needs reflected as annual FGN budget line item Sub-activities         2.6.1.1 Conduct a rapid assessment of information needs of decision makers DCDPA, NPC, NGOs, Dev Partners, SMOH, LGAs 5m Feb-04 Information needs of policy makers identified Expressed commitment on RHCS by policy makers 2.6.1.2Develop and implement plan to respond to identified information needs DCDPA, NPC, NGOs, Dev Partners, SMOH, LGAs 2m Apr-04 Advocacy plan of action in place Expressed support on RHCS by policy makers 2.6.1.3Facilitate annual RHCS information seminar DCDPA, NPC, Dev. Partners 3m Oct 04 & Annually No. of participants attending annually Policy makers update on RHCS issues 2.6.2 Improve policy makers access to RHCS data  DCDPA, Dev. Partners, NPC Total: 5m   Periodic presentation of RHCS data to key policy makers Annual parliament policy and budgetary support for RHCS priorities Sub-activities           2.6.2.1 Restructure format of data presentation for use by policy makers DCDPA, Dev. Partners, NPC 5m Mar-04 No. of advocacy tools developed and used Improved policy decisions and resources for RHCS Component Summary Component No. 3: Logistics Strategic Objective: To ensure that contraceptives and condoms are supplied in the right quantities in a timely and efficient manner at all levels. Major Issues Addressed: Forecasting; Procurement; Distribution; Logistics management capacity; Logistics Management Information System Monitoring and Evaluation Estimated Budget (Naira): 2.9415b Indicators: Sufficient commodities procured to meet public sector needs Adequate mix of contraceptive commodities available in SDP and stores Increased logistic data available for management decision making Percent decrease in stock out rate of contraceptives in SDPs and stores Availability of adequate/appropriate mechanisms Assumptions: Donors & Government ready to provide funds to support the process Component: 3.0 Logistics Objective: 3.1 To increase the capacity to accurately estimate national contraceptive and condom needs Issues Addressed: Forecasting Coordinating Agency: FMOH/DCDPA Assumptions: Political stability Availability of funds Availability of LMIS returns Functional Contraceptive Cost Recovery System Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 3.1.1 Use data to forecast short and long-term contraceptive needs. Total: 6.5m Subactivities 3.1.1.1 Form and hold periodic meetings of forecasting and procurement committee for Public Sector and NGO contraceptive needs CLMS Division DCDPA 1.5m Nov-2003 to 2007 Number of meetings held. 3.1.1.2 Use logistics (consumption/issues) data, to forecast short and long-term contraceptive quantities CLMS/MIS Divisions DCDPA 1.5m March annually Annual contraceptive forecasts. Annual contraceptive forecasts available 3.1.1.3 Use service statistics and demographic data to adjust forecast CLMS/MIS Divisions DCDPA March annually Number of forecasts using logistics data. 3.1.1.4 Provide regular forecast reports to decision-makers and other stakeholders CLMS Division DCDPA 1.5m April annually Number of reports sent to decision makers Number of key stakeholders utilising forecasting reports for decision making. 3.1.1.5 Build local capacity to forecast contraceptive needs CLMS Division DCDPA 2m Jun 2004 Number of Officers trained. Number of Officers skilled in forecasting. Component: 3.0 Logistics Objective: 3.2 To procure adequate and quality RH commodities for the public sector that will meet the needs of the client Issues Addressed: Procurement Quality Assurance (QA) Coordinating Agency: FMOH/DCDPA Assumptions: Continued Donor support Governments willingness to provide funds Availability of data Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activities 3.2.1 Procure required contraceptives including condoms for STIs & HIV/AIDS PA Division/ UNFPA Total: 2,006.5m Subactivities 3.2.1.1 Prepare procurement plan based on forecast needs and remaining pipeline CLMS Division/ UNFPA April annually Procurement plan prepared Sufficient commodities to fill pipeline 3.2.1.2 Develop procurement guidelines detailing procurement processes (approvals, requirements, product registration, customs clearance, letters of donation) and place orders CLMS Division/ UNFPA 1.5m Sep-03 Procurement Guideline produced 3.2.1.3 Place orders and procure commodities CLMS Div./ UNFPA 2,600m (for 5 years) Annually Quantity and types of contraceptive commodities procured 3.2.1.4 Develop a procurement tracking and reporting strategy to ensure that decision makers and stakeholders have accurate and timely data for decision making CLMS Division/ UNFPA on-going Procurement Information kit produced and in use 3.2.1.5 Carry out random selection of contraceptives at central, state and LGA stores for QA tests. CLMS Division/ NAFDAC/ NASCP 5m On receipt to Central & annually No. of QA tests Procured products meet quality standards Component: 3.0 Logistics Objective: 3.3 To improve the timely supply of contraceptives and condoms to the client in an efficient manner. Issues Addressed: Distribution Logistics management capacity LMIS Coordinating Agency: FMOH/DCDPA Assumptions: LMIS forms will be continually available States, LGAs and service providers will render accurate returns. Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 3.3.1 Design and implement program to support an improved national RH commodities logistics management system. Total: 140m Subactivities 3.3.1.1 Conduct study to determine needs of contraceptive logistics system. DCDPA - RH & CLMS, UNFPA & USAID Done July to August 2002 Needs assessment conducted. Percentage reduction in stock outs at Public Sector Health facilities. 3.3.1.2 Design logistics management system handbook (SOP) in response to identified needs. DCDPA - RH & CLMS, UNFPA & USAID 5m Done October 2002 to March 2003 Contraceptive logistics system redesigned. 3.3.1.3 Develop & conduct contraceptive logistics management training program and utilise for training at all levels, including military and paramilitary personnel, PPFN and other NGOs. DCDPA - RH & CLMS, SMOH & LGA PHC 80m March 2003 to March 2004 on-going Number of people trained using the CLMS Handbook and training manual. 3.3.1.4 Use LMIS to monitor stock levels at service delivery points to assess system effectiveness and identify problem areas DCDPA - RH & CLMS 25m Nov 2003 & then on-going Percentage of SDPs/stores rendering spontaneous LMIS returns. 3.3.1.5 Provide stock to all facilities using revised CLMS DCDPA - RH & CLMS Cost under transportati-on (15m) Jun 2003 & on-going % of SDPs with adequate contraceptive mix. Number and types of commodities available at SDPs. 3.3.1.6 Print handbook, training manual and management tools for all levels DCDPA and Partners 30m Jun 2003 & on-going Component: 3.0 Logistics Objective: 3.3 To improve the timely supply of contraceptives and condoms to the client in an efficient manner. [continued] Issues Addressed: Logistic management capacity LMIS Coordinating Agency: FMOH/DCDPA Assumptions: Continued Donor support Governments willingness to provide funds Availability of data Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 3.3.2 Design logistics management information system to monitor contraceptive supply throughout the system and provide data for decision-making. DCDPA, USAID, UNFPA, SMOH & LGA Total: 10m Functional Logistics Management Information in place at all levels Effective logistics Management System at all levels Subactivities 3.3.2.1 Review existing data collection instruments at service delivery points and warehouses DCDPA, USAID, UNFPA As in 3.3.1.2 (5m) As in 3.3.1.2 Number of reviewed data collection instruments. Percentage reduction in stock outs at Public Sector Health facilities. 100% consumption and issue data available for forecasting. 3.3.2.2 Identify logistics data needs for revised system DCDPA, USAID, UNFPA As in 3.3.1.2 As in 3.3.1.2 All relevant data required for inventory management identified. 3.3.2.3 Prepare forms to collect required data DCDPA, USAID, UNFPA As in 3.3.1.2 As in 3.3.1.2 Number and types of the revised LMIS forms available. 3.3.2.4 Prepare job aids and integrate in the CLMS training on completing LMIS forms and flow of information up and down the system DCDPA, USAID, UNFPA, SMOH & LGA PHC 5m (Job aids) March 2003 & on-going Number of persons trained to use the revised LMIS forms. Component: 3.0 Logistics Objective: 3.3 To improve the timely supply of contraceptives and condoms to the client in an efficient manner. [continued] Issues Addressed: Logistic management capacity LMIS Coordinating Agency: FMOH/DCDPA Assumptions: Continued Donor support Governments willingness to provide funds Availability of data Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 3.3.3 Design and implement transportation strategy that assures availability of contraceptives and condoms at the SDP level DCDPA/ Development Partners Subactivities 3.3.3.1 Assess FMOH transportation options for different levels DCDPA/ DELIVER Done Transportation options for different levels assessed. States have adequate contraceptive mix for distribution. 3.3.3.2 Select effective and feasible transportation strategies for FMOH to assure transportation between levels and develop implementation plans DCDPA/ USAID/ UNFPA Done 3.3.3.3 Test alternative strategy and confirm cost effectiveness DCDPA Nov 2003- Jul 2004 A cost effective transportation option identified. 3.3.3.4 Implement chosen FMOH transportation strategy DCDPA RH Division June 2003 on-going Number of States receiving commodities three times a year. Component: 3.0 Logistics Objective: 3.4 To provide a coordinated monitoring and supervision programme for the effective implementation of the revised CLMS Issues Addressed: Regular monitoring through use of LMIS data. Periodic supervision of logistics personnel and activities Coordinating Agency: FMOH/DCDPA Assumptions: Funds for supervision available. Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 3.4.1 Strengthen capacity to effectively monitor and supervise the logistics management system Total: 57m Subactivities 3.4.2.1 Develop supervisory checklist DCDPA, UNFPA, USAID, SMOH, LGAs Jul-03 Supervisory checklist developed Revised CLMS functioning effectively. 3.4.2.2 Build capacity of 15 Central Logistics Officers in monitoring and supervision DCDPA/ Development Partners 3m Mar 2004 No of Central Logistics Officers trained in monitoring & supervision % of SDP personnel carrying out logistics functions accurately. 3.4.2.3 Produce a supervision plan for each level of the system DCDPA, SMOH June '03 on-going Supervision plan for each level of system in place %of stores carrying out error free logistics activities 3.4.2.4 Analyse LMIS data and give feedback periodically DCDPA, SMOH 2m July and on-going % of LMIS data analysed and feedback given. Supportive supervision provided to lower levels 3.4.2.5 Conduct supervisory visits to States and SDPs DCDPA, SMOH & LGA 50m Yearly for Federal, 3 times for States, 4 times for LGA Number of supervisory visits conducted to each level of the system. Feedback from supervision used for management decisions 3.4.2.6 Write supervision reports and institute corrective action as necessary DCDPA, SMOH & LGA PHC 2m Yearly for Federal, 3 times for States, 4 times for LGA Number of adequate supervision reports written. Component: 3.0 Logistics Objective: 3.5 To provide adequate storage facilities for contraceptives at all levels Issues Addressed: Assessment of storage facilities Development of storage guidelines Coordinating Agency: FMOH/DCDPA Assumptions: Funds for storage facilities available State and LGA governments willing to provide stores Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 3.5.1 Enhance capacity to adequately store contraceptive commodities at all levels Total: 121.5m Subactivities 3.5.2.1 Conduct needs assessment of storage facility DCDPA/ USAID Done Jun/Jul 2002 % of contraceptive commodities stored in good conditions. Quality contraceptives maintained in the system 3.5.2.2 Renovate State and LGA FP Stores DCDPA/ SMOH/ LGA 65m Aug-03 No. of FP stores at State and LGA levels renovated 3.5.2.3 Develop storage guidelines for all levels. DCDPA/ USAID/ UNFPA Jul-03 Types of storage guidelines developed. 3.5.2.4 Develop job aids for stores DCDPA/ USAID Jun-03 Number of job aids developed. 3.5.2.5 Train personnel on storage guidelines at all levels as part of CLMS training DCDPA/ UNFPA/ SMOH/LGA PHC/ Military & Paramilitary Agencies 41.5m Sep 2003 & on-going No. of personnel trained on storage guidelines 3.5.2.6 Store contraceptive commodities adequately FMOH/ SMOH/ LGA PHC/SDPs 15m Sept 2003 on-going % of storage facilities meeting good storage capacity. % of stores meeting storage guideline requirements. Component Summary Component No. 4: Service Delivery Strategic Objective: To increase secure and permanent access to and use of safe, comprehensive, reliable and high quality contraceptives and related services. Major Issues Addressed: Training Infrastructure support Data collection and analysis Supervision Provider skills Method mix Service quality Client satisfaction Counseling Estimated Budget (Naira): 1063.4 million Indicators: % SDPs with trained CSPs % of SDPs with basic minimum package for RHCS % of SDPs offering FP Services % of clients expressing client satisfaction. Assumptions and Risks: Availability of funds, Political stability, timely release of funds, budgetary release of funds Continued donor support Peaceful co-existence and lack of communal strife Continued acceptance of the programme Component: Service Delivery Objective: 4.1 To increase access of individuals and couples to safe, comprehensive, and reliable reproductive health commodities and services. Issues Addressed: Community participation in RHCS initiatives Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Assumptions: Communities consider RH programs a priority Funds availability Political stability Absence of communal strife Favourable political environment risks: Acceptance by men folk to women’s use of RH/FP services Activity Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 4.1.1 Design and implement program to support community-based RHCS FMOH/DCDPA, NPHCDA, NGOs networks SMOH LGA Community leaders Uniformed services   29m   a. Increased sustainable community support for local RHCS programs. b. Increased community participation in RHCS programs c. Increased service demand and utilization by the community. Sub activities           4.1.1.1 Facilitate 6 zonal local-level forums to solicit community responses on RH commodity security issues. Ditto 12m December 2004 Number of local level fora established 4.1.1.2 Design, implement, and support community-based RHCS initiative based on forum discussions. Ditto 12m Feb 2005 Number of CBD RH initiatives developed and supported 4.1.1.3 Design, implement, and support program to strengthen women's' and men's community committees and networking initiatives. Ditto 5m June 2005 Number of functional women’s community committee initiatives   Component: 4.0 Service Delivery Objective: 4.2 To improve RHCS service delivery through research Issues Addressed: Research focus; Effective use of research findings Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Assumption: Representation of RH research committee will include broad-based participation form public sector, NGOs, donor, and private sector& technical managers. Availability of funds to commission researches. Stakeholders will use research findings to improve programming Activity Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 4.2.1 Define and implement action-oriented approach to research findings. FMOH/DCDPA, HPR, NPHCDA, Academia, development partners, NGOs networks  177.5m     Recommendations of research findings used to influence RHCS service delivery Sub activities           4.2.2.1 Expand the scope of existing RH research committee and conduct bi-annual meetings ditto 5.0m March 2004 and ongoing RH Research committee meetings held twice a year               4.2.2.2Organize priority setting workshop for RHCS research. ditto 1.5m April, 2004  Research priorities set and in use 4.2.2.3 Call for proposals RH research committee 2m (0.5m yearly) May 2004 -(yearly) No. of proposals received 4.2.2.4 Source for funds to commission prioritized research.  ditto 1.0m July- 2004 (continuous) Amount of funding for research realised 4.2.2.5 Release grants for research FMOH and partners 160.0m (40m yearly) Sept, 2004 (yearly) Number of research studies commissioned 4.2.2.6 Develop and implement response to findings of conducted researches FMOH and partners   continuous  Research findings used for RHCS programme implementation 4.2.2.7 Disseminate research findings FMOH and partners 8m (2m yearly) June 2005 onwards Number of research findings disseminated Component: 4.0 Service Delivery Objective: 4.3 To improve the quality of care through the development and application of protocol, and guidelines. Issues Addressed: Quality of care; Provider capacity Coordinating Agency: FMOH/DCDPA Assumptions: 1. That guidelines developed will cover issues affecting both women and men regardless of marital status. 2. That committee will explore ways in which to improve monitoring and supervision. 3. Minimal attrition of CSPs trained for the 5 year period Activity Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 4.3.1 Assess and respond to technical barriers to quality RH service delivery DCDPA, NPHCDA, all developmental partners    273.5m 1. %of service providers rendering quality services 2. % of clients satisfied with services               Sub activities         4.3.1.1 Conduct training needs assessments.  ditto 5m Mar, 2004 Training gaps identified 4.3.1.2 Mobilize support for RH training initiatives. ditto 0.5m May, 2004 Amount of resources mobilized for training 4.3.1. 3 Facilitate technical roundtable to develop program to strengthen technical guidelines on (RH service delivery (Job aids, SOPS) for all cadres of providers. ditto 8m Dec 2004  Technical roundtable meeting held and outcome reported 4.3.1.4 Develop appropriate tools and guidelines to strengthen the technical aspects of service delivery (Job aids, SOPs etc.) ditto 18m April 2005 Selected technical guidelines developed 4.3.1.5. Conduct relevant trainings for service providers (pre-service; clinical, TOT for RH/FP services) ditto 150.0m September, 2004 onwards Number of service providers trained 4.3.1.6 Facilitate formation and operations of committee focused on monitoring performance in the use of operational guidelines ditto 90.0m March,2005 onwards No. of M&E visits conducted and reports submitted 4.3.1.7 Develop and implement quality assurance program for service delivery.(in 6 zonal centres of excellence)  ditto 2m (0.5m yearly) June,2005 onwards Number of quality assurance sites commissioned Component: 4.0 Service Delivery Objective: 4.3. To improve quality of care through the development and application of protocol and guidelines. Issues Addressed: Service management; Client access Coordinating Agency: FMOH/DCDPA Assumptions: Political stability Availability of funds Continued donor support Activity Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 4.3.2 Assess and respond to operational barriers to RH access  FMOH/CDPA  564.4m   Changes in operational guidelines implemented on established schedule. % of clients satisfied with services provided       Sub activities         4.3.2.1 Compile basic minimum equipment requirement for different levels of service delivery centres  FMOH/ DCDPA 2.4m Feb, 2004 Basic minimum equipment requirement compiled 4.3.2.2. Conduct needs assessment of service delivery points vis-à-vis infrastructure and equipment (using step down approach)  ditto 30m Apr - June 2004 Report of Needs assessment written 4.3.2.3 Facilitate renovation of infrastructure and supply of basic minimum equipment FMOH SMOH LGA 500m (1000 facilities at 0.5 million per facility) Aug, 2004 onwards No. of Service delivery points renovated/ equipped with basic minimum package % of Service delivery points with basic minimum package 4.3.2.4 Facilitate technical roundtable of RH/RP coordinators to identify operational barriers to strengthen the quality of RH services. FMOH/DCDPA 32.0m (for 4 years) August 2004 (yearly) Yearly RH/FP coordinators meetings held   4.3.2.5 Facilitate formation and operations of committee focused on monitoring programmes to reduce operational barriers in RH service delivery  ditto Joint activity with 4.3.1.6. Aug 2005 onwards Monitoring committee formed No. of M&E visits conducted Component: 4.0 Service Delivery Objective: 4.4 To identify and respond to information gaps which will stimulate research and data collection related to RH commodity security issues Issues Addressed: Data quality Coordinating Agency: FMOH Assumptions: Availability of resources to set up data bank Activity Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 4.4 Improved quality of RHCS data available for research purposes HPR, DCDPA  18m   Expanded RHCS database Improved utilization of RHCS data for management decision making Sub activities           4.4.1 Assess qualitative and quantitative needs of RHCS information system HPR, DCDPA 2m June 2004 Information needs for RHCS identified   4.4.2 Develop response to data assessment HPR, DCDPA 2m July 2004 Plan of Action and programme developed   4.4.3Develop and implement training program for data analysts HPR, DCDPA 4m August 2004 No. of training held. No. of people trained   4.4.4Set up databank and consolidate GON, NGO and private sector data related to RHCS HPR, DCDPA 10m Sept 2004 & onwards Functional databank set up   Component Summary Component No. 4: Demand Strategic Objective: To create processes and mechanisms that promote a balance between the demand for and the supply of quality contraceptives and to promote demand in order to increase low-levels of contraceptive prevalence. Major Issues Addressed: Market segmentation Unmet demand CPR Public awareness & sensitization Estimated Budget (Naira): 300.5 million Indicators: Increased use of public health services for RH/FP services % increase in Contraceptive Prevalence Rate. Assumptions: Availability of funds Political stability, Adequate budgetary allocation Timely release of budgeted funds Male support for women participation Absence of communal strife Continued donor support Continued acceptance of the programme Component: Demand Objective: To increase demand for RH Commodities. Issues Addressed: Availability and use of IEC materials, Behavioural change to RH Coordinating Agency: FMOH/DCDPA Assumptions and Risks: Political Stability Availability of funds Activities and Sub activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 5.1. 1.1 Develop and implement IEC/BCC programmes for increased RH commodities utilization DCDPA, NFPA, SAID, National & State IEC Committees, SMOH, LGA/ PHC NGOs  210m Feb 2004 – Feb 2005 BCC programmes developed and being used at all levels Increased service utilisation of RH services  Sub activities   5.1.1.1 Carry out inventory of existing IEC/BCC materials and activities DCDPA 5m Feb 2004 Number & Types IEC/BCC materials collected Types of IEC/BCC activities documented Inventory of IEC/BCC materials and activities used to inform future planning, reviews, and programming 5.1.1.2 Review existing IEC/BCC materials and activities on RH/FP DCDPA National & State IEC Committees NGOs 5m June 2004 Report of review of IEC/BCC materials and activities Report used for developing appropriate and culturally relevant IEC/BCC materials 5.1.1.3 Assess existing IEC structures at the National, State & LGA levels DCDPA (To be implemented with sub activity 5.1.1.1.) Feb 2004 No and Types of existing IEC structures at state and LGA levels assessed Capacity of existing IEC structures documented 5.1.1.4 Strengthen the IEC structures for dissemination of information on RH/FP DCDPA, SMOH 10m July 2004 & quarterly No of meetings held by National, State & LGA IEC Committees IEC Structures resuscitated and functioning 5.1.1.5 Train multi-media professionals on the development and use of appropriate IEC/BCC materials on RHCS DCDPA, UNFPA, USAID, PICB, JHU/CCP, NGOs, Other Development Partners 15m July to Sept 2004 No. of multi-media professionals trained in IEC/BCC materials development No of IEC/BCC developed by multi media professionals 5.1.1.6 Train officers on the development of IEC/ BCC materials at National & State levels DCDPA UNFPA, USAID JHU 15m March to April 2004 No of Federal & State officers trained in IEC/BCC material development Federal and state officers develop and use appropriate IEC/BCC materials for RHCS 5.1.1.7 Strengthen the capacity of service providers in Interpersonal communications & counselling skills & BCC materials development DCDPA UNFPA, USAID JHU Consultant 80m Sep to Dec 2004 No. of service providers trained No. of workshops conducted Increased utilization of RH services and clients satisfaction 5.1.1.8 Develop, print and distribute new and appropriate IEC/BCC materials DCDPA UNFPA, USAID JHU/CCP 80m July 2004 to March 2005 to August 2004 No. & Types of IEC/BCC materials produced and distributed IEC Materials available and in use in all SDPs and in the communities Component: 5.0 Demand Objectives: To strengthen the existing multi-sectoral and multi-disciplinary Institutions to promote demand creation activities for RH commodities utilization Issues Addressed: Behavioural change amongst Providers and Communities Coordinating Agency: FMOH Assumptions: Political Stability Funds Availability Favourable organizational policies and position Activities and Sub activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 5.2.1 Activity To promote and support positive behavioural change amongst providers and the community  SMOH, LGA  70.5m   BCC programmes developed and being used at all levels in dramas, songs, community out reach programmes * Increased service utilisation of RH/FP services * Increased awareness on RH/FP issues Sub-Activities 5.2.1.1Conduct study to determine factors that drive demand DCDPA Consultant 10m Feb - April 2004 Report of study available Programmers have access to, and use, data for messages and activities redesign 5.2.1.2: Organise dissemination workshop on RHCS for all levels of media organisations DCDPA PICB NGOS 5m May 2004 No. of persons that participated at the dissemination workshop on RHCS No. of mass media organisation professionals producing positive write-up and programmes on RHCS 5.2.1.3: Conduct advocacy activities to sensitize the traditional, community and religious leaders by Top Management Team led by the Hon. Minister of Health, through (visits, etc) DCDPA UNFPA USAID & Other Development Partners CSOs 20m Jan 2004 and on-going No. of Advocacy activities conducted National KAP indicates positive KAP at all levels towards RH issues 5.2.1.4. Organise study tours for Policy makers, traditional and community leaders to countries with success stories on RH/FP DCDPA Developmental partners 20m October 2004 onwards Number of persons taken on study tours Increased political commitment for RH/FP issues by policy makers at government and community levels 5.2.1.5: Disseminate information on RHCS through print & electronic media DCDPA PICB Media Houses 10m Mar 2004& on-going No. of TV/Radio Slots or Print adverts Information on RHCS disseminated 5.2.1.6: Monitor and evaluate demand creation activities DCDPA National & State IEC Committees 5.5m Sept 2004 & bi-annually No. of M&E visits to each level of the system * % of Providers, IEC Officers and media workers providing information on RHCS accurately. * Mid-term and end of programme evaluation carried out Component: 5.0 Demand Objectives: To provide for a coordinated response to unmet need and demand for RH commodities Issues Addressed: Response to demand; Response to unmet need through demand satisfaction Coordinating Agency: FMOH/DCDPA Assumptions and Risks: That Public sector and key stakeholders will maintain support for RHCS Risks: That demand creation will exceed realistic expectations of supply Activities and Sub activities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators 5.3.1: Enhance capacity to respond to identified demand for RH commodities    20m   5.3.1 Task Force collaborate response to increased demand Clients receive desired RH commodities Sub-Activities   5.3.1.1 Analyze current audience segmentation  DCDPA Consultants  5m    Report of Analysis Segmented data on RH/FP audience available and used for planning  5.3.1.2: Facilitate the formation and operations of a joint Private sector, NGOs, donor task force to promote and support a coordinated response to identified demand for RH commodities DCDPA Dev. Partners 5m June 2004 and bi-annually No. of meetings of Task Force held No of RH/FP networks established Clients receive desired RH commodities 5.3.1.3: Develop strategy to satisfy demand through new channels and expanded choice, especially through increased male and youth involvement in FP/RH DCDPA PICB IEC Committee 10m Jan 2005  Number of new initiatives being implemented to reach men and youth Increased involvement of men and youth in RH activities Component Summary Component No. 6: Coordination Strategic Objective: To develop and promote political, governmental, organizational, public/private and socio-cultural coordination focused on ensuring continued planning, management and provision of contraceptives and related services. Major Issues Addressed: Donor participation Private sector participation Information dissemination Regulatory barriers Infrastructure development Data collection, analysis, and feedback CS planning, monitoring, and evaluation Estimated Budget (Naira): 96.7m Indicators: Improved management and information dissemination Improved public-private-NGO sector partnerships Assumptions and Risks: Funds will be available Staff of coordination base will be committed to support RHCS Increased and sustained donor funding. Political stability Component: 6.0 Coordination Objective: 6.1 To promote rational use of internal and external resources for improved management CS programs Issues Addressed: Government coordination of CS policy and programs Effective use of resources Capacity development Coordinating Agency: FMOH/DCDPA Assumptions: Adequate and skilled manpower will be available at national and state levels to support coordination GON and donors commit adequate resources for RHCS program management Personnel at national and state levels will be committed Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 6.1.1 Design and implement process for coordinating all CS initiatives among collaborating partners DCDPA/FMOH, SMOH, Dev. Partners, NGO, CSOs, Private sector Total: 40m RHCS coordination focus in plase Functional and effective coordination system Subactivities 6.1.1.1 Facilitate national RHCS steering committee. Ditto 5m 2003 & on-going Coordinating body meets on a periodic basis Effective & efficient RHCS program coordination at national levels. 6.1.1.2 Facilitate national donor sub-committee. Ditto 15m On-going Quarterly meetings of National RHCS Steering Committee facilitated Effective & efficient RHCS program coordination at national levels. 6.1.1.3 Establish and maintain data base of initiatives contributing to RHCS. DCDPA/FMOH 10m Feb 2005 & on Data bases for RHCS established & maintained RHCS databases used as the basis for decision-making and coordination 6.1.1.4 Establish and facilitate multisectoral RHCS steering committees at state level. SMOH, Dev. Partners, NGO, CSOs, Private sector 10m Feb 2005 & on State RHCS steering committees established Enhanced inter-sectoral collaboration with full participation of civil society and private sector program implementation Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 6.1.2 Strengthen management capacity DCDPA/FMOH, SMOH, Dev. Partners, NGO, CSOs, Private sector Total: 11m Management staff trained and equipped Effective and functional management structures exist at all levels Subactivities 6.1.2.1 Facilitate organizational development (O.D.) study to assess SPARHCS structural management needs. Ditto 3m Jul-04 OD study conducted Strong and sustainable capacity for management of RHCS programs developed. 6.1.2.2 Design and implement programs to address O.D. findings. Ditto 3m Aug. 2004 O.D. study programs designed and implemented based on study results Strong and sustainable capacity for management of RHCS programs developed. 6.1.2.3 Design and implement policy analysis training for Coordination Ditto 2.5m Oct. 2004 RHCS management staff trained in policy analysis Strong and sustainable capacity for management of RHCS programs developed. 6.1.2.4 Design and implement M&E training for Coordination Ditto 2.5m Oct 2004 RHCS management staff trained in M&E for coordination Strong and sustainable capacity for management of RHCS programs developed. Component: 6.0 Coordination Objective: 6.2 To promote increased NGO/private sector participation towards RHCS Issues Addressed: Clinical access Service management Effective use of limited resources Public/private/NGO collaboration on service quality, management, coordination, M&E Coordinating Agency: FMOH/DCDPA Assumptions: Public/private and NGO sectors willing to collaborate Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 6.2.1 Promote public and private sector partnership in providing clients with increased access to and use of RH services DCDPA/ FMOH, Dev.partners, NGOs, CSOs, Private sector Total: 11.5m Oct-Dec 2003 Public and private sector forum established at all levels Effective and enhanced private sector inputs and participation in RHCS Subactivities 6.2.1.1 Conduct baseline study to assess NGO and private sector knowledge, attitude and practices related to the promotion of public access to and use of RH services. Ditto 2m May 04 Compendium of NGOs/CSOs in RHCS updated NGO/private sector baseline KAP study completed Access to & use of RH services by clients in NGO/Private sector SDPs increased 6.2.1.2 Define and implement strategies to address findings associated with NGO/Private Sector study Ditto 3m May 04 Results of KAP utilized to develop and implement strategies to strengthen public/private/ NGO collaboration Access to & use of RH services by clients in NGO/Private sector SDPs increased 6.2.1.3 Establish routine coordination meetings on RHCS issues with NGOs/Private sectors Ditto 5m Mar 2004 bi-annually Bi-annual co-ordination meetings held Access to & use of RH services by clients in NGO/Private sector SDPs increased 6.2.1.4 Create a communications strategy to keep stakeholders informed of successes and challenges and to improve stakeholder interest and participation. Ditto 1.5m Jun 2005 & quarterly Newsletters produced & disseminated quarterly Access to & use of RH services by clients in NGO/Private sector SDPs increased Component: 6.0 Coordination Objective: To ensure that key decision makers and policy makers, financial managers and opinion leaders at national, state and local government levels have access to current and reliable data related to policies and budgets in support of RH Commodity Security requirements Issues Addressed: Information dissemination Coordinating Agency: FMOH/DCDPA Assumptions: Political stability Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 6.3 Develop and maintain an RHCS website MIS/M&E of DCDPA Total: 10m February 2004 RHCS website established Website information on RHCS available to guide stakeholder decisions Component: 6.0 Coordination Objective: To ensure that health care providers, service and program managers effectively collect, analyze and use current and reliable data related to the promotion of RH commodity security in their geographical areas Issues Addressed: Capacity development MIS expansion and sustainability Information dissemination Coordinating Agency: FMOH/DCDPA Assumptions: MIS data will be utilized Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 6.4 Strengthen existing RHCS information systems program MIS/M&E of DCDPA Total: 6m Subactivities 6.4.1 Train users, developers and programmers in use of the computer MIS/M&E DCDPA, States and LGA 4m May-04 Training program developed and implemented Number of programmers trained Information required for decision making is available in a timely manner 6.4.2 Train health providers and service and program managers in data collection and analysis MIS/M&E DCDPA 2m Jun-04 Training program developed and implemented No. of health providers trained in data collection and analysis Information required for decision making is available in a timely manner Component: 6.0 Coordination Objective: 6.5 To ensure effective monitoring and evaluation of the RH Commodity Security Strategy Issues Addressed: Monitoring indicators Fragmented information systems Effective IT structure Data validity and reliability Coordinating Agency: FMOH/DCDPA Assumptions: MIS data will be utilized Availability of funding Activities and Subactivities Implementing Agencies Estimated Budget (Naira) Timing Output Indicators Outcome Indicators Activity 6.5.1 Develop RHCS M&E plan through consensus to include selection of quality of care indicators DCDPA Total: 0.7m Subactivities 6.5.1.1 Facilitate task force to review/modify RHCS indicators Ditto 0.5m Dec-03 No. of Indicators identified Consensus among key decision-makers achieved on RHCS indicators Improved management and quality of care in RHCS 6.5.1.2 Disseminate RHCS revised indicators Ditto 0.2m Dec-03 No. of dissemination workshops Improved management and quality of care in RHCS 6.5.1.3 Develop and implement M&E Activity Workplan Ditto   Dec-03 Activity workplan produced and RHCS program monitored using M&E indicators Improved management and quality of care in RHCS Activity 6.5.2 Develop information technology (IT) structure to support effective monitoring of RH Commodity Security Strategy HPR/MIS of DCDPA Total: 8m Subactivities 6.5.2.1 Carry out health sector and RHCS information technology needs assessment HPR/MIS of DCDPA 2m Jan. 2004 RHCS information needs identified RHCS Information Technology system functional 6.5.2.2 Develop and implement response to information technology needs assessment HPR/MIS of DCDPA 1m Mar- Apr 2004 Information technology structure defined, developed and maintained based on results of needs assessment RHCS Information Technology system functional 6.5.2.3 Establish and support program of periodic review, maintenance and indicated update of information technology structure HPR/MIS of DCDPA 5m Nov 04 Ongoing Information technology structure reviewed yearly Information technology structure maintained monthly Information technology structure updated every one to two years RHCS Information Technology system functional REFERENCES Federal Ministry of Health, National Reproductive Health Policy and Strategy – Nigeria, 2001 Federal Ministry of Health, National Reproductive Health Strategic Framework and Plan, 2002-2006, FMOH, June 2002 Nigerian Demographic and Health Survey 1999, National Population Commission, Abuja Nigeria: SPARHCS Field Test Report, September 23, 2002 Nigeria’s Pathway to Contraceptives Security: Key Issues and Challenges. (Draft), February 16, 2003 Nigeria National Policy on Population for Sustainable Development (Draft), 2002 WHO, National Manpower and Facilities for Reproductive Health in Nigeria Assessment Report, 2002 Needs Assessment on National Contraceptives Logistics Management System, June-July, 2002 PAGE

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